OIC (Opioid Induced Constipation)

If you take opioid pain medicine, you might have trouble with bowel movements or will develop issues. Opioid-induced constipation (OIC) is one of the most common side effects of this type of pain medication. Constipation resulting from opioid-based pain relievers is called OIC. OIC differs from other forms of constipation because it is a direct result of the medication’s effects on the human intestine. Once it starts, it can continue as long as the patient continues taking the pain medication. If you take opioids for pain, here are seven signs you should consider speaking with your health provider to determine if you are at risk. Any of the following seven signs could indicate you suffer from OIC.

Understanding opioids

Opioids are a powerful type of drug that doctors commonly prescribe to patients because they offer pain killing or analgesic properties. Examples include morphine, methadone, oxydodone, and codeine. Common brand names of opioids include Vicodin, Demerol, Fentanyl, OxyContin, Darvon, Percocet and Demerol, to name a few.

Opioids are classified by the type of materials used in their manufacturing process. Some of the first opioids were made from a resin produced by the opium poppy and are known as natural opioids. They include morphine and codeine. When manufacturers begin with these same natural resins but altered them chemically, the resulting drugs are part of a class of medications known as semi -synthetic opioids. Oxycodone and hydrocodone are two members of this class of drugs. Scientist manufacture other drugs beginning with non-opioid substances in laboratories beginning with other materials. This class of drugs including methadone, is classified as synthetic opioids. The body also naturally produces endorphins and other types of endogenous opioids but these do not interfier with bowel movements.

How do these drugs work?

Opioid receptors are found in the gastrointestinal tract, brain and spinal cord. Opioids bind to these proteins and prevent the brain from sensing pain. At the same time, the opioid stimulates the brain’s pleasure centers, causing the user to sense a state of euphoria.

The proper use of opioids

In the field of medicine, opioids are useful because they block the brain from perceiving pain. In palliative care patients, pain is one of the factors found most distressing as the individual approaches the end of his or her life. Pain is a common complaint in 70% of advanced cancer patients and 65% of individuals facing death from non-malignant disease. Doctors prescribe opioid-based medication to lower their pain while improving their overall quality of life. Patients who are in the advanced stages of these diseases most commonly receive long-term prescriptions for opioids.

Do opioids have side effects?

While beneficial in preventing pain, these medications also result in side effects. The patient may experience nausea and drowsiness. The medication depresses the overall respiratory system and slows the patient’s breathing rate. Opioids also slow the movement of matter through the digestive system and cause constipation. For many patients, OIC is an uncomfortable side effect of the medication they take to reduce their pain. For a large percentage of patients, opioid addiction is also a side effect.

Opioid Induced Constipation Symptoms

Nausea: Opioid medications cause some patients to experience queasiness or vomiting. Some of the nausea is due to consumption of the medication itself; however, patients who cannot pass a bowel movement often experience an enhanced nauseous feeling. When the nausea is combined with a reduction in bowel movements, OIC should be suspected.

Discomfort: For some OIC sufferers, pressing on the abdomen reveals tenderness. It is important to consult with your physician anytime the stomach becomes sensitive to touch as such pain can indicate a serious medical condition. However, if you experience tenderness in the abdomen along with the other symptoms we outline, constipation is a common cause.

Bloating: Many patients suffering OIC also describe feelings of bloating, fullness, swelling or tightness in their abdomen. They might also experience excess gas. While bloating can have many different causes, one common cause is constipation.

Painful Toileting: If you suffer OIC, you might find yourself experiencing pain and straining when you use the bathroom. For some OIC patients, the process is a fight through the entire toileting process that leaves them feeling sore once they finish. OIC can cause your normal bathroom break to become a workout.

Incomplete Evacuation: One of the bothersome side effects of opioid action on the gastrointestinal track is a feeling that your gut is still full even after you use the bathroom. Some patients describe the sensation of feeling that they are not having full bowel movements when they are victims of OIC.

Less Frequent Bowel Movements: The medication can decrease the number of bowel movements you have during a week. If you notice such a frequency decrease when taking opioids, you could be suffering OIC.

Hard Stools: Patients with OIC often experience hard, dry stools. Such stools are an indication of constipation. While you may not find it intuitive to study your stools, fecal matter appearance provides some important clues to overall digestive health. Normal bowel movements should have a smooth, soft shape resembling the shape of a sausage or snake. Constipated bowel movements often break into pieces or lumps or have a dry, cracked appearance. If you take opioid pain medication, check your stool the next time you go to the bathroom.

It may be possible to reduce some or all of the symptoms using home remedies. If the symptoms are mild, consider these simple remedies first. However, if the symptoms continue longer than seven to 14 days, you should see your doctor.

OIC home remedies

Natural fiber laxatives: These over-the-counter medications help to increase fiber and can help if you have trouble increasing fiber in your diet. Some are available as powders you mix in a liquid drink. If you do not enjoy the gritty texture of the mix-ins try the capsule form.

Improve your diet: Reduce the fat and processed foods in your diet. Try eating five or six smaller meals instead of three large one. Choose natural foods for a healthier you.

Exercise: Exercise can help to relieve many health issues, including OIC. The process of exercising helps to reduce stress while stimulating the bowels. Another plus is that exercise results in better health overall.

Mineral oil: This OTC medication provides lubrication while also softening the stool; however, it is only recommended as a short-term solution for constipation.

Check your fiber: Fiber helps you to be more regular and produces a softer stool. There are many sources of fiber, including oatmeal, fruits, prunes or prune juice, bran cereal, apple cider (not juice), rhubarb, apricots, watermelon, grapes, cabbage, asparagus, raisins and dried fruits, whole grains and carrots. This fiber helps to improve the efficiency of the digestive system.
Soften the stool: Over the counter medications including the stool softener Docusate cause the muscles of the intestines to contract rhythmically to mechanically soften stool. Other types of OTC stool softeners add moisture to the stool so it passes with less strain.

Increase your water intake: The human body is composed largely of water. If you are dehydrated, your poop tends to dry out. Drink plenty of water each day to ensure your body stays hydrated and your stool passes easily.

Squat to Pot: The typical American toilet eliminates squatting to defecate. A device called the Squatty Potty lifts the legs so the body is in a more natural position. The position relieves the stress on the colon and is said to reduce issues with both constipation and hemorrhoids.

Combine your methods: With the above tips, you are not limited to a single choice. Add two, three or more to your regiment to find what actually helps. If one works for a while but the issue returns, try using a different remedy.

Prescription Medications and Treatments for OIC
If the home remedies do not bring relief, it is time to talk with your doctor.

Medications and drugs that treat OIC

Because opioids often cause constipation, your doctor may prescribe another medication along with your pain medication. Doctors find it beneficial to provide the two medications instead of eliminating the opioid because of the increase pain control brings to the patient’s life. Your doctor may prescribe a laxative or cathartics with the pain medication as a preventative measure. Cathartics are medications that accelerate defecation while laxatives make the process easier, usually working as a stool softener. Some medications provide relief using both mechanisms.

While most patients find relief of OIC with the other methods, sometimes doctors recommend rectal intervention. These measures can help to relieve OIC symptoms quickly so the patient is more comfortable.

Possible prescription medications to treat OIC

Emollients: These oily substances provide lubrication and soften the stool so it passes easier.
Bulk cathartics: These laxatives also soften the stool and increase bulk.

Osmotics: these medications work by increasing the water in the intestines. Water softens the stool and increases bulk.

Stimulants: These medications provide a direct counteraction of opioids on the gut by increasing the motility of the intestines so the stool is forced through the digestive system.

Prokinetic drugs: These medications reduce the absorption of electrolytes and water by the intestines, increasing the weight of the stools. They reduce transit time and increase the frequency of defecation.

Other options include medications that prevent opioids from slowing the bowels and reduce OIC.

Methylnaltrexone (sold under the brand name Relistor(R)) works by blocking the gut’s opioid receptors and has a limited ability to cross the barrier between the brain and blood. It only affects the receptors in the gastrointestinal track, so it reverses OIC without causing symptoms of withdrawal or preventing the opioid from reducing pain in the rest of the body.

It also helps to restore bowel function when patients face advanced illnesses and require opioids for their pain-relieving benefits. The injectable medication is designed to target OIC. It should be given along with the opioid so the patient can receive the opioid benefit without the side effect of OIC.

This medication decreases the chance of constipation by reducing the opioid’s effect on the GI tract while maintaining the pain medication’s ability to bring relief and increase the patient’s quality of life.

For patients who have the option, the best choice to stop OIC is eliminating the use of pain-relieving opioids. However, in patients where this is not an option, doctors should consider the appropriate OIC treatment.